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Aging and the Asian Hollow Upper Eyelid
While the typical youthful Asian upper eyelid is fuller than in the Occidental, lid hollowing is a common change in the Asian population that can begin during the early twenties. As the fat inside the socket begins to decrease, it becomes less effective at inflating the upper eyelid from behind. A depression appears midway between the brow and lashes due to this deep underlying fat loss.
Although the same sort of aging change may occur in anyone, it is much more common in people of Asian descent
As time progresses, the depression may deepen considerably and cause the overlying skin to sink into a fold vaguely mimicking an upper crease but more commonly a series of tiny incomplete folds, a feature sometimes called a "triple eyelid." The shape of the bone above the eye may become visible just above the hollow.
Because hollow eyes are features seen most commonly in the older Asian person, its occurrence during younger years can be worrisome because it makes the face look older.
A similar sort of hollowing may occur after inappropriate fat removal during double eyelid surgery.
Treatment is difficult. Minimal changes are best left alone. If hollowing becomes advanced, the only workable option involves placing either a graft or implant into the socket to plump up the lid skin from behind.
Early efforts now abandoned were directed at surgical implantation of tiny silicone-filled bags not unlike miniaturized breast implants the size of a medicine capsule.
Current approaches include tissue grafting of either fascia lata obtained from the large muscle located beneath the temple or small pieces of fat obtained from the lower abdomen. Injection of fat obtained by liposuction has been tried but is seldom of benefit because of rapid resorption and because it is hard to administer into the cavity around the eyeball.
Unable to address the underlying cause, some doctors have instead recommended removing the skin between any lower crease and the higher line of depression to create a single crease. Unfortunately, many patients consider the resulting very high double eyelid to look worse than the starting point.
Treatment of this vexing but common Asian cosmetic condition remains problematic as no procedure can reliably yield the precise amount of correction and symmetry typically demanded by many younger patients.
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